Sitcom Syncope: A Case Series and Literature Review of Gelastic (Laughter-Induced) Syncope

Syncope is a common complaint that is frequently evaluated without identifying a precipitating cause. Gelastic (laughter-induced) syncope is an uncommon and poorly understood condition. We describe 3 patients who experienced loss of consciousness during vigorous laughter. Each patient had an extensi...

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Bibliographic Details
Published in:Postgraduate medicine 2010-11, Vol.122 (6), p.137-144
Main Authors: Thiagarajah, Prashan H., Finkielstein, Dennis, Granato, Jerome E.
Format: Article
Language:English
Subjects:
Aged
Blood Pressure Determination
Diagnosis, Differential
Electrocardiography
Electroencephalography
Female
gelastic syncope
Heart Rate - physiology
Humans
Laughter - physiology
Laughter - psychology
laughter-induced syncope
Male
Middle Aged
neurally mediated syncope
neurocardiogenic syncope
Neuropsychological Tests
Physical Examination - methods
Risk Assessment
situational syncope
Syncope - diagnosis
Syncope - etiology
Syncope, Vasovagal - diagnosis
Syncope, Vasovagal - etiology
Syncope, Vasovagal - physiopathology
Tilt-Table Test
vasodepressor syncope
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Summary:Syncope is a common complaint that is frequently evaluated without identifying a precipitating cause. Gelastic (laughter-induced) syncope is an uncommon and poorly understood condition. We describe 3 patients who experienced loss of consciousness during vigorous laughter. Each patient had an extensive medical evaluation, including a comprehensive history and physical examination, 12-lead electrocardiography, chest radiograph, routine blood analysis, polysomnography, tilt table testing, 2-dimensional transthoracic echocardiography, nuclear or echocardiographic stress testing, and 24-hour Holter monitoring. All 3 patients had an abnormal response to head-up tilt table testing, with either a significant decrease in systolic blood pressure or inappropriate heart rate response on achieving an upright position. These observations together with our review of the literature suggest that gelastic syncope may be a variant of vasodepressor syncope. Knowledge of this condition, its pathophysiology, and potential treatment options may be of value to clinicians when evaluating patients with unexplained loss of consciousness.
ISSN:0032-5481
1941-9260
DOI:10.3810/pgm.2010.11.2231